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Ritalin Stopped Working?


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#1 In_Remission_laura c

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Posted 13 October 2011 - 01:07 PM

For the last 5 years I've been taking 15mg of methylphendiate (Ritalin) 3x/day for my depression. It got me out of a major depressive episode when nothing else would (a systematic working through of other antidepressant options, along with a rEEGm, confirmed that I'm quite medication resistant). It's kept me stable all through college. In short it's been a godsend.

But now, in my senior year of college, I'm becoming depressed again. Fatigue, hypersomnia along with nightmares, crying spells, lack of interest in most things, trouble concentrating, significantly increased irritability... the works. There could be some external factors for this, so I am in the process of getting in touch with my therapist back home (I never found someone I clicked with and trusted here), but I've been in similar situations in past years, and as far as I can tell the Ritalin always kept me stable. I'm wondering what changed.

My question is: has anyone else had Ritalin (specifically as an antidepressant) poop out on them? And if so, did you find that a dosage increase, or a switch to a slightly different stimulant, helped?

(For what it's worth, I know this is a conversation I also should have with my psychiatrist. But again, it's the college town problem. My primary psychiatrist, the one who I've worked with for years, put me on Ritalin, and trust to tinker with things, is back home, on the other side of the country. And my psychiatrist here is a glorified prescription writer who I see because she's literally the only person in town who can write scrips. I don't trust her to make any changes, unless they're cleared with my doctor back home first.)



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#2 notfred

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Posted 13 October 2011 - 01:33 PM

The PI allows for Ritalin up to 60 mgs and I know people sometimes take more. So, as you like Ritalin I would up the dose provided the side effects are manageable. From there a logical next choice cold be a stronger stim, like Adderal, Vyvance, Dexadrine, or dextroamphetamine.

I have been on psycomeds since 1985 and my experience is almost all psycomeds poop out at some point. Benzos have been the only thing that has not, for me. I have been on stims several times in my life but never long enough to tell if they poop out.

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I am in full remission (296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.

 

Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Abilify 15 mg, (Aripiprazole), Eszopiclone 6 mg (Lunesta), Vyvance 70 mg, (Dextroamphetamine) Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal)
PRN: Lorazepam 1-4 mg (Ativan), Alprazolam 1-2 mg (Xanax), Dextroamphetamine 10-40 mg (Dexedrine), Propranolol 20-40 mg (Inderal), Ondansetron 8 mg (Zofran)

Supps: Multi-vitamin/mineral, Vitamin D-3 2,000 IU, Omega-3-acid ethyl esters 4 g (Lovaza), Fish oil 1-4 g.

Dx: Depression, Insomnia, ADHD-PI, Epilepsy, Dyspraxia, Tremor

I also take allergy and diabetes + it's complications meds.

All doses are a daily total.


#3 horselover

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Posted 14 October 2011 - 01:34 PM

Laura, since you don't trust the judgement of your local pdoc, have you tried calling your faraway pdoc to see if you can work something out? No one here should be your ultimate source for meds decisions.

Edited by horselover, 14 October 2011 - 01:37 PM.

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HL

Current meds:
Viibryd 30mg
Abilify 10mg
Lamotrigine 100mg
levothyroxine 0.05mg
Protonix 40mg qam for GERD


Previous meds.:
Lexapro
Pristiq
Ativan

#4 In_Remission_laura c

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Posted 15 October 2011 - 09:39 AM

I haven't been under more stress, necessarily, but it's very different stress than in previous years. So yes, it seems likely that a lot of this is situational.

And that I probably do need more of a cocktail, because yeah, the Ritalin isn't really handling my other issues very well. It was great when I was doing better, but now that things are worse, all the other things (mainly the obsessive compulsive issues) are getting worse again (of course). And this:

I think a switch to dextroamphetamine, Adderal or Vyvanse would benefit you greatly. Your DX says OCD spectrum disorders and the dextroamphetamines help to treat OCD, while Ritalin tends to make them worse.


...is definitely an interesting consideration for me. Because the Ritalin actually did work for tamping down the obsessive-compulsive issues for a while. But it's the opposite now.

Laura, since you don't trust the judgement of your local pdoc, have you tried calling your faraway pdoc to see if you can work something out? No one here should be your ultimate source for meds decisions.


You're absolutely right, and I meant to make that clearer in my post, then got distracted talking about my doc in town. I know that I need to consult with a trustworthy psychiatrist, because there really is no replacement for that. I just figured I'd try and consult with people here, get the lay of the land as it were, so that I can figure out whether to talk at all to my doc in town, or just jump directly to getting in touch with my real one back home.


I really appreciate all your responses, thank you. I think I'm starting to get a better handle on my options/how to go about addressing this issue before it becomes even more of one.

#5 In_Remission_laura c

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Posted 15 October 2011 - 09:49 AM

Oh, also, I meant to add:

The bottom line is that you have a diagnosis of major depressive disorder, generalized anxiety disorder and OCD. Ritalin will only go so far to treat your depression and trust me, it hasn't pooped out on you. You just need treatment with a good 'ol antidepressant, something like Luvox.


The problem there is that, as we learned through a long process of trying different meds and then confirmed when I got my rEEG, I'm rather medication resistant, particularly with SSRIs. So I don't know that Luvox would do much for me, unfortunately.

#6 horselover

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Posted 15 October 2011 - 11:17 AM


Laura, since you don't trust the judgement of your local pdoc, have you tried calling your faraway pdoc to see if you can work something out? No one here should be your ultimate source for meds decisions.


I just figured I'd try and consult with people here, get the lay of the land as it were, so that I can figure out whether to talk at all to my doc in town, or just jump directly to getting in touch with my real one back home.

I wonder if it would be possible or even helpful (depending on how open your local pdoc is) to try to see if you could get your two pdocs to consult with each other to help you. There are other things for depression besides SSRI's that could be tried.
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HL

Current meds:
Viibryd 30mg
Abilify 10mg
Lamotrigine 100mg
levothyroxine 0.05mg
Protonix 40mg qam for GERD


Previous meds.:
Lexapro
Pristiq
Ativan


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